Better care for staff is key to better care for older people

Creating a culture of care and respect is the key to preventing the mistreatment of older people in care homes and hospitals, according to a report commissioned by the Department of Health and Comic Relief.

The report, ‘Respect and Protect’, summarises the findings of a major programme of research. Supportive leadership and an environment of trust and openness can help prevent staff from doing harmful things, but a culture that does not value and respect staff can mean that good people may end up providing neglectful or unsafe care.

The report, which draws together the findings of 11 individual research studies examining the experiences of older people and care staff in care homes and hospitals in England and Wales, is a wide-ranging analysis of the experience of institutional care and recommends practical steps which can be taken to help prevent the mistreatment of staff as well as residents. Whilst recognising that much good care is provided, the report contributes to answering the question ‘why do good people sometimes do bad things?'

Harry Cayton OBE, Comic Relief Trustee, said: “If we want good care for older people, we need to support and value the staff who look after them. Staff who are under pressure and are poorly trained are most at risk of failing to provide good quality care.

“The findings in this report, identified through robust academic research, will provide valuable practical advice for everyone in the care sector.”

Care and Support Minister Norman Lamb said: “We want better care for everyone and the government is committed to delivering a compassionate health and social care system that protects vulnerable older people from the risk of abuse.
“Hospitals now have a duty to be open and honest if bad care does happen and wilful neglect will become a criminal offence. Care companies and their directors will also be held to account for the quality of care their organisations provide.
“I am grateful to Comic Relief for this report and the insight it will give to the leaders of our health and care organisations, as they have a responsibility to ensure their staff have the support and training they need to provide excellent care.”

The key findings include:
•    Many care staff face work-related stress or ‘burn out’ and some on the ‘frontline of care’ face a real risk of physical harm or verbal abuse.
•    Much good and excellent care of older people is taking place. Overall the quality of care suffers more from lack of resources and time pressures than from the bad actions or inactions of care staff.
•    Abuse and neglect do occur, especially long-term neglect that results from poor organisational systems and practices, and there are risks from physical environments ill-suited to the care of frail older people.

The report recommends that care providers need to develop and maintain strong cultures of safe and respectful care, supporting and valuing their staff, as well as the people they care for. They should also identify and monitor the signs of organisational ill-health and stress at an early stage as this is critical in preventing mistreatment of staff as well as residents and patients.

It goes on to suggest that promoting a safe and respectful care culture, actively challenging abuse and neglect all day, every day is the responsibility of all managers, owners, professionals, commissioners and regulators.  

Andrea Sutcliffe (right), chief inspector of Adult Social Care at the Care Quality Commission said: "While many care homes and hospitals are providing older people with good and excellent care, it is unacceptable that others are suffering from neglect and abuse. Poor or mediocre care cannot be tolerated.
“I am encouraged that the report offers some positive and practical suggestions for how we can all work together to help prevent such abuse, neglect and poor practice from emerging in the first place. I will ensure that the report’s findings inform how CQC inspects, monitors and regulates adult social care services in future.”


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